General Surgery

Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers
COPYRIGHT 2004 The Gale Group Inc.

General surgery

Definition

General surgery is the treatment of injury, deformity, and disease using operative procedures.

Purpose

General surgery is frequently performed to alleviate suffering when a cure is unlikely through medication alone. It can be used for such routine procedures performed in a physician's office, as vasectomy , or for more complicated operations requiring a medical team in a hospital setting, such as laparoscopic cholecystectomy (removal of the gallbladder). Areas of the body treated by general surgery include the stomach, liver, intestines, appendix, breasts, thyroid gland, salivary glands, some arteries and veins, and the skin. The brain, heart, lungs, eyes, feet, kidneys, bladder, and reproductive organs, to name only a few, are areas that require specialized surgical repair.

New methods and techniques are less invasive than older practices, permitting procedures that were considered impossible in the past. For example, microsurgery has been used in reattaching severed body parts by successfully reconnecting small blood vessels and nerves. Laparoscopic techniques are more efficient, promote more rapid healing, leave smaller scars, and have lower postoperative infection rates.

Demographics

All surgeons receive similar training in the first two years of their residency (post-medical school) training. General surgeons are the surgical equivalent of family practitioners. General surgeons typically differ from other surgical specialties in the operations that they perform. This difference is most easily understood by exclusion. For example, procedures involving nerves or the brain are usually performed by neurosurgeons. Surgeons having specialized training during the final three years of their residency period similarly focus on other regions of the body. General surgeons may perform such procedures in the absence of other surgeons with specialized training. Such procedures are the exception, however, rather than the rule.

In the United States, there are approximately 700,000 physicians licensed to practice medicine and surgery. Experts estimate that fewer than 5% of these physicians (approximately 35,000) restrict their practices to general surgery.

Description

In earlier times, surgery was a dangerous and dirty practice. Through the middle of the nineteenth century, the number of people who died from surgery approximately equaled the number of those who were cured. With the discovery and development of general anesthesia in the mid-nineteenth century, surgery became more humane. As knowledge about infections grew and sterile practices were introduced into the operating room , surgery became more successful. The last 50 years have brought continued advancements.

General surgery experienced major advances with the introduction of the endoscope. This is an instrument for visualizing the interior of a body canal or a hollow organ. Endoscopic surgery relies on this pencil-thin instrument, equipped with its own lighting system and small video camera. The endoscope is inserted through tiny incisions called portals. While viewing the procedure on a video screen, the surgeon then operates with various other small precise instruments inserted through one or more of the portals. The specific area of the body to be treated determines the type of endoscopic surgery performed. For example, colonoscopy uses an endoscope, which can be equipped with a device for obtaining tissue samples for visual examination of the colon. Gastroscopy uses an endoscope inserted through the mouth to examine the interior of the stomach. Arthroscopy refers to joint surgery. Abdominal procedures are called laparoscopies.

Endoscopy is frequently used in both treatment and diagnosis especially involving the digestive and female reproductive systems. Endoscopy has advantages over many other surgical procedures, resulting in a quicker recovery and shorter hospital stays. This noninvasive technique is being used for appendectomies, gallbladder surgery, hysterectomies, and the repair of shoulder and knee ligaments. However, endoscopy has such limitations as complications and high operating expense. Also, endoscopy does not offer advantages over conventional surgery in all procedures. Some literature states that, as general surgeons become more experienced in their prospective fields, additional noninvasive surgical procedures will become more common options.

One-day surgery is also termed same-day or outpatient surgery . Surgical procedures in this category usually require two hours or less and involve minimal blood loss and a short recovery time. In the majority of surgical cases, oral medications control postoperative pain. Cataract removal, laparoscopy , tonsillectomy , repair of broken bones, hernia repair, and a wide range of cosmetic procedures are common same-day surgical procedures. Many individuals prefer the convenience and atmosphere of one-day surgery centers, as there is less competition for attention with more serious surgical cases. These centers are accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Accreditation Association for Ambulatory Health Care.

Diagnosis/Preparation

The preparation of persons for surgery has advanced significantly with improved diagnostic techniques and procedures. Before surgery, a candidate may be asked to undergo a series of tests, including blood and urine studies, x rays, and specific heart studies if the person's past medical history or physical examination warrants this testing. Before any surgical procedure, the physician will explain the nature of the surgery needed, the reason for the procedure, and the anticipated outcome. The risks involved will be discussed, along with the types of anesthesia to be utilized. The expected length of recovery and limitations imposed during the recovery period are also explained in detail before any surgical procedure.

Surgical procedures most often require some type of anesthetic. Some procedures require only local anesthesia, produced by injecting the anesthetic agent into the skin near the site of the operation. The person remains awake with this form of medication. Injecting anesthetic agents near a primary nerve located adjacent to the surgical site produces block anesthesia (also known as regional anesthesia), which is a more extensive local anesthesia. The person remains conscious, but is usually sedated. General anesthesia involves injecting anesthetic agents into the blood stream or inhaling medicines through a mask placed over the person's face. During general anesthesia, an individual is asleep and an airway tube is usually placed into the windpipe (trachea) to help keep the airway open.

As part of the preoperative preparation, surgical patients will receive printed educational material and may be asked to review audio or videotapes. They will be instructed to shower or bathe the evening before or morning of surgery and may be asked to scrub the operative site with a special antibacterial soap. Instructions will also be given to eat or drink nothing by mouth for a determined period of time prior to the surgical procedure.

Precautions

Persons who are obese, smoke, have bleeding tendencies, or are over 60 need to follow special precautions, as do persons who have recently experienced such illnesses as pneumonia or a heart attack. People taking such medications as heart and blood pressure medicine, blood thinners, muscle relaxants , tranquilizers, anticonvulsants, insulin, or sedatives may require special laboratory tests prior to surgery and special monitoring during surgery. Special precautions may be necessary for persons using such mind-altering drugs as narcotics, psychedelics, hallucinogens, marijuana, sedatives, or cocaine since these drugs may interact with the anesthetic agents used during surgery.

Risks

One of the risks involved with general surgery is the potential for postoperative complications. These complications include but are not limited to pneumonia, internal bleeding, and wound infection as well as adverse reactions to anesthesia.

Normal results

Advances in diagnostic and surgical techniques have greatly increased the success rate of general surgery. Contemporary procedures are less invasive than those practiced a decade or more ago. The results include reduced length of hospital stays, shortened recovery times, decreased postoperative pain, and decreases in the size and extent of surgical incisions. The length of time required for a full recovery varies with the procedure.

Morbidity and mortality rates

Mortality from general surgical procedures is uncommon. The most common causes of mortality are adverse reactions to anesthetic agents or drugs used to control pain, postsurgical clot formation in the veins, and postsurgical heart attacks or strokes.

Abnormal results from general surgery include persistent pain, swelling, redness, drainage, or bleeding in the surgical area and surgical wound infection, resulting in slow healing.

Alternatives

For the removal of diseased or nonvital tissue, there is no alternative to surgery. Alternatives to general surgery depend on the condition being treated. Medications, acupuncture, or hypnosis are used to relieve pain. Radiation is an occasional alternative for shrinking growths. Chemotherapy may be used to treat cancer. Some foreign bodies may remain in the body without harm.

See also
Admission to the hospital;
Anesthesia evaluation;
Outpatient surgery;
Reoperation.

Wake Forest University School of Medicine [cited April 5, 2003]. <http://www.bgsm.edu/surg-sci/atlas/atlas.html>.

L. Fleming Fallon, Jr, MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

General surgery is performed by a physician with specialized training in surgery. It is most commonly performed in an outpatient facility adjacent to a hospital or in an operating room of a hospital. Very minor procedures such as abscess incision and drainage or the removal of a small or superficial foreign body may be performed in a professional office.

QUESTIONS TO ASK THE DOCTOR

What tests will be performed prior to surgery?

Which body parts will be affected?

How will the procedure affect daily activities after recovery?

Where will the surgery be performed?

What form of anesthesia will be used?

What will the area look like after surgery?

Is the surgeon board certified?

How many similar procedures has the surgeon performed?

What is the surgeon's complication rate?

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General Surgery

Gale Encyclopedia of Medicine, 3rd ed.
COPYRIGHT 2006 Thomson Gale

General Surgery

Definition

General surgery is the treatment of injury, deformity, and disease using operative procedures.

Purpose

General surgery is frequently performed to alleviate suffering when a cure is unlikely through medication alone. It can be used for routine procedures performed in a physician's office, such as vasectomy, or for more complicated operations requiring a medical team in a hospital setting, such as laparoscopic cholecystectomy (removal of the gallbladder). Areas of the body treated by general surgery include the stomach, liver, intestines, appendix, breasts, thyroid gland, salivary glands, some arteries and veins, and the skin. The brain, heart, eyes, and feet, to name only a few, are areas that require specialized surgical repair.

New methods and techniques are less invasive than previous practices, permitting procedures that were considered impossible in the past. For example, microsurgery has been used in reattaching severed body parts by successfully reconnecting small blood vessels and nerves.

Precautions

Patients who are obese, smoke, have bleeding tendencies, or are over 60, need to follow special precautions, as do patients who have recently experienced an illness such as pneumonia or a heart attack. Patients on medications such as heart and blood pressure medicine, blood thinners, muscle relaxants, tranquilizers, insulin, or sedatives, may require special lab tests prior to surgery and special monitoring during surgery. Special precautions may be necessary for patients using mind-altering drugs such as narcotics, psychedelics, hallucinogens, marijuana, sedatives, or cocaine since these drugs may interact with the anesthetic agents used during surgery.

Description

In earlier times, surgery was a dangerous and dirty practice. Until the middle of the 19th century, as many patients died of surgery as were cured. With the discovery and development of general anesthesia in the mid-1800s, surgery became more humane. And as knowledge about infections grew, surgery became more successful as sterile practices were introduced into the operating room. The last 50 years of the 20th century have seen continued advancements.

Types of General Surgery

General surgery experienced major advances with the introduction of the endoscope. This is an instrument for visualizing the interior of a body canal or a hollow organ. Endoscopic surgery relies on this pencilthin instrument, capable of its own lighting system and small video camera. The endoscope is inserted through tiny incisions called portals. While viewing the procedure on a video screen, the surgeon then operates with various other small, precise instruments inserted through one or more of the portals. The specific area of the body treated determines the type of endoscopic surgery performed. For example, colonoscopy uses an endoscope, which can be equipped with a device for obtaining tissue samples for visual examination of the colon. Gastroscopy uses an endoscope inserted through the mouth to examine the interior of the stomach. Arthroscopy refers to joint surgery, and abdominal procedures are called laparoscopies.

Endoscopyisusedinbothtreatment and diagnosis especially involving the digestive and female reproductive systems. Endoscopy has advantages over many other surgical procedures, resulting in a quicker recovery and shorter hospital stay. This non-invasive technique is being used for appendectomies, gallbladder surgery, hysterectomies and the repair of shoulder and knee ligaments. However, endoscopy does not come without limitations such as complications and high operating expense. Also, endoscopy doesn't offer advantages over conventional surgery in all procedures. Some literature states that as general surgeons become more experienced in their prospective fields, additional non-invasive surgery will be a more common option to patients.

ONE-DAY SURGERY. One-day surgery is also termed same-day, or outpatient surgery. Surgical procedures usually take two hours or less and involve minimal blood loss and a short recovery time. In the majority of surgical cases, oral medications control postoperative pain. Cataract removal, laparoscopy, tonsillectomy, repair of broken bones, hernia repair, and a wide range of cosmetic procedures are common same-day surgical procedures. Many individuals prefer the convenience and atmosphere of one-day surgery centers, as there is less competition for attention with more serious surgical cases. These centers are accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Accreditation Association for Ambulatory Health Care.

Preparation

The preparation of patients has advanced significantly with improved diagnostic techniques and procedures. Before surgery the patient may be asked to undergo a series of tests including blood and urine studies, x rays and specific heart studies if the patient's past medical history and/or physical exam warrants this testing. Before any general surgery the physician will explain the nature of the surgery needed, the reason for the procedure, and the anticipated outcome. The risks involved will be discussed along with the types of anesthesia utilized. The expected length of recovery and limitations imposed during the recovery period are also explained in detail before any general surgical procedure.

Surgical procedures most often require some type of anesthetic. Some procedures require only local anesthesia, produced by injecting the anesthetic agent into the skin near the site of the operation. The patient remains awake with this form of medication. Injecting anesthetic agents into a primary nerve located near the surgical site produces block anesthesia (also known as regional anesthesia), which is a more extensive local anesthesia. The patient remains conscious, but is usually sedated. General anesthesia involves injecting anesthetic agents into the blood stream and/or inhaling medicines through a mask placed over the patient's face. During general anesthesia, the patient is asleep and an airway tube is usually placed into the windpipe to help keep the airway open.

As part of the preoperative preparation, the patient will receive printed educational material and may be asked to review audio or videotapes. The patient will be instructed to shower or bathe the evening before or morning of surgery and may be asked to scrub the operative site with a special antibacterial soap. Instructions will also be given to the patient to ingest nothing by mouth for a determined period of time prior to the surgical procedure.

Aftercare

After surgery, blood studies and a laboratory examination of removed fluid or tissue are often performed especially in the case of cancer surgery. After the operation, the patient is brought to a recovery room and vital signs, fluid status, dressings and surgical drains are monitored. Pain medications are offered and used as necessary. Breathing exercises are encouraged to maximize respiratory function and leg exercises are encouraged to promote adequate circulation and prevent pooling of blood in the lower extremities. Patients must have a responsible adult accompany them home if leaving the same day as the surgery was performed.

Risks

One of the risks involved with general surgery is the potential for postoperative complications. These complications include—but are not limited to—pneumonia, internal bleeding, and wound infection as well as adverse reactions to anesthesia.

Normal results

Advances in diagnostic and surgical techniques have increased the success rate of general surgery by many times compared to the past. Today's less invasive surgical procedures have reduced the length of hospital stays, shortened recovery time, decreased postoperative pain and decreased the size of surgical incision. On the average, a conventional abdominal surgery requires a three to six-day hospital stay and three to six-week recovery time.

Abnormal results

Abnormal results from general surgery include persistent pain, swelling, redness, drainage or bleeding in the surgical area and surgical wound infection resulting in slow healing.

Citation styles

Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).

Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

The Chicago Manual of Style

American Psychological Association

Notes:

Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.

In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.